In 2009 I wrote,
"Ten years after being gut-whacked and I'm still on a diet." That is what I wanted to title my book which was eventually published as
"Day 6: Beyond the 5 Day Pouch Test." In the introduction I explained, "No matter what treatment a person with the disease of morbid obesity seeks there is a tough journey to follow. There is no "easy way out." I am still on a diet. And it doesn't look to change anytime soon."

Jump forward to spring 2017: I'm 18-years removed from surgery and I'm still on a diet! I guess I'm in it for life. At one time this realization would have scared the jelly out of my doughnut. But these days it's my security blanket. I know I have a disease: obesity. I have been surgically treated for the disease. By following the prescribed lifestyle plan including diet and exercise I can work with my surgery to keep the disease in remission. That is the cold hard reality for all of us living after WLS. (See the article below
Obesity Reclassified from 2013 when the AMA official categorized obesity a disease.)

Mind you, this acceptance was not easily achieved. I rebelled with vigor against the rules abandoning diet and physical activity in favor of hoping for the best. Leaving things to chance, however, did not help me control my obesity before surgery or after surgery. In our WLS community the path commonly trends to complete compliance following surgery followed by a detour along the road to chance and then, hopefully, a calm resolve of acceptance and renewed commitment to the lifestyle that supports our health and weight management goals. I've observed this trend for a decade and the anecdotal evidence predicts most patients will experience this learning curve.

I appreciate your time today, I know your Inbox is loaded with messages needing your attention. May I also take this opportunity to thank those who support our
LivingAfterWLS Bookstore and other publication outlets. The LivingAfterWLS research work is self-funded and it is through your support that we are able to conduct clean research without becoming prejudiced by sponsors expecting a quid pro quo return of favorable findings in exchange for funding. Have a fabulous week and may good health be yours to enjoy!

Kaye Bailey

It's not your imagination!
Your body is fighting everything you do to lose weight

by Kaye Bailey

LivingAfterWLS, LLC. (C) 2017 - ALL RIGHTS RESERVED

You and I, members of the weight loss surgery patient community, understand the endless battle against our own body when we take action to lose excess weight. We may not understand the metabolic science but we know from experience that efforts to lose weight and keep it off are resisted by the body with the same hard-headed determination a rebellious teenager resists curfew.

We have excess body weight because a survival mechanism that stores excess body weight to prevent starvation is an over-achiever. The disease obesity is complicated by our evolution from hunter-gatherers for whom any weight loss was a threat to survival. To combat that threat the body evolved a physiological process to make it so weight could be easily and quickly regained.

"The body actually senses the weight loss as a threat to survival and begins to release hormones that lead to feelings of hunger to ensure a strong motivation to obtain as many calories as possible," says Los Angeles area bariatric surgeon Dr. Michael Feiz M.D., F.A.C.S . He explains that these biological processes may very largely account for what is known as the "yo-yo" effect in which individuals manage to lose weight, only to quickly regain it.

I was among the many obesity sufferers who before weight loss surgery had managed to lose and regain significant weight several different times. What a head-trip this cycle is! The euphoria of weight loss followed by the shame and disappointment of weight regain. You too? I understand.

A 25 Million Year ProcessLooking at the greater picture, the fight to los e weight is not singular against our own body: the fight is against 25 million years of human evolutionary history. "Humans are not self-made creations dietarily, but rather have an evolutionary history as anthropoid primates stretching back more than 25 million years," reports Katharine Milton in the American Journal of Clinical Nutrition. She continues, "This is a history that shaped their nutrient requirements and digestive physiology." We carry that history and the accompanying nutritional needs and metabolic physiology in our DNA.

In the personal struggle to manage obesity a nod to our ancestral evolution is in order. "It seems prudent for modern-day humans to remember their long evolutionary heritage as anthropoid primates and heed current recommendations," reports Milton. Such is easier said than done: the difficulty in treating obesity was formally recognized in 1958 when the Cornell Conference on Therapy reported, "Most obese patients will not remain in treatment, most will not lose significant poundage, most would regain it promptly."

Not much has changed in the 60 years since the Cornell Conference. Dr. Feiz explains that, while it is common knowledge that exercise and strict adherence to a balanced, low-calorie diet are surefire methods for weight loss, the difficulty of making sticking to low calorie diets over the long-term means that people with large amounts of excess weight to lose typically struggle both to lose it and, even more so, to keep it off. Dr. Feiz notes that one way in which bariatric surgery is effective is that it can address these physiological and hormonal factors that make dieting so difficult.

The Weight Loss Surgery Option"For people with severe obesity and large amounts of excess weight to lose, weight loss surgery is the best medical intervention known to improve both the quality and length of their lives." Speaking specficially of the gastric sleeve procedure Dr. Feiz said, "This is a scientifically proven weight loss surgery technique that works in two ways. Firstly, the procedure removes a significant portion of the stomach, which makes its overall capacity much smaller. For the patient, this results in feeling satiated faster from smaller meals and servings. Secondly, the procedure curbs the release of ghrelin, a hunger inducing hormone."

Surgery does not release patients from personal responsibility, but it does provide an eye-opening realization that obesity is a disease
--a medical condition treated with major gastrointestinal surgery-- and sufferers must employ all means to fight responsibly

against this ailment just as they would any other life-threatening condition. Dr. Feiz says, "Of course, the full benefits of the procedure are not attained unless the patient fulfills his or her commitment to eating significantly less overall. As part of treatment and recovery from obesity a program that includes a dietitian and counseling will guide the patients' changing relationship with food.

This is 25 million years of biological evolution we are battling. Be kind to yourself and build a support army including your bariatric center, your social and family support groups, and your ongoing intelligence gathering. Remember, all of life is evolutionary and we each are a work in progress.

WASHINGTON (AP) The American Medical Association (AMA) now considers obesity a disease that requires medical intervention, treatments and preventative measures.

The resolution to consider obesity a disease was passed on Tuesday at the association's annual meeting.

"The suggest

ion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes," reads one of the final paragraphs of the resolution (courtesy NPR's posting of the full document).

The AMA hopes the reclassification will change how doctors treat patients; that they will treat obesity as a disease rather than a lifestyle choice or condition.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans," said AMA board member Patrice Harris, M.D. "The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and type 2 diabetes, which are often linked to obesity."

Obesity has been linked to risk increases for heart disease, Type 2 diabetes, stroke, liver disease, sleep apnea, breathing problems, osteoarthritis and joint pain, infertility, sexual side effects and cancers of the breast, colon, esophagus, pancreas and kidneys. A recent cancer study also found a rise in obesity-related cancers over the last thirty years.

This new position on obesity could have a "tremendous impact on [obesity] legislation in Washington [and] with insurance companies," Dr. Louis Aronne, an obesity specialist at New York-Presbyterian Hospital in New York City, said on "CBS This Morning" Wednesday.

It is also possible that bariatric surgeries including Lap-band procedures or gastric bypass surgeries would now be covered by more insurers based on the AMA's reclassification, he told CBS.

While the AMA's recognition of obesity as a disease is not legally binding, the decision by the largest association of physicians in the country could have far reaching implications.

"The American Medical Association's recognition that obesity is a disease carries a lot of clout," Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis, said to USA Today . "The most important aspect of the AMA decision is that the AMA is a respected representative of American medicine. Their opinion can influence policy makers who are in a position to do more to support interventions and research to prevent and treat obesity."

OBESITY: noun.Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. It is defined by body mass index (BMI) and further evaluated in terms of fat distribution via the waist-hip ratio and total cardiovascular risk factors. BMI is closely related to both percentage body fat and total body fat.

Participation Helps! It cannot be overstated the value that comes from following a 5DPT participant group that uses the plan to get back to the basics they've forgotten. New patients can learn and benefit from the mistakes of others and be well-equipped to quickly spot behaviors that may take us off track from the basics. Don't wait to find yourself well into the danger zone to start learning from others.
It is the shared experience of the group that makes the individual strong.

Shared with permission from Protein First: Understanding and Living the First Rule of WLS by Kaye Bailey pp. 74-75.

"I have found this is a mindful way to get a pasta-fix without going overboard. The recipe comes together quickly with affordable ingredients that can be substituted to take advantage of fresh seasonal produce. Served as a cold salad this makes a great take-to-work lunch. To streamline cooking cook the peas and asparagus with the pasta and avoid using a steamer basket over another pan of boiling water. The vegetables could also be steamed in the microwave oven. To decrease the simple carbs use only 4 ounces of bow tie pasta, I've tried this and the salad is just as delicious as with 8 ounces of pasta.

Directions: Cook pasta according to package directions, omitting salt and fat, timing carefully. During the first five minutes while pasta cooks snap off tough ends of asparagus. Remove scales from stalks, if desired. Cut asparagus into 1-inch pieces. During final 3 minutes as pasta cooks add asparagus and peas to pasta and continue cooking until pasta is done and vegetables are tender. Reserve 1/4 cup of pasta cooking water and drain pasta and vegetables. Place pasta and vegetables in a large bowl and toss with green onions, salt, olive oil, chopped tomato and lemon juice. Flake tuna and toss in salad; add pasta water as needed for desired consistency. Season with ground pepper. Serve warm or chilled.

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